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New Australian dietary guidelines: experts respond

Eat plenty of vegetables and fruit, choose mostly unprocessed grains and cereals, cut back on salt, fat and sugar, and get more active. jamesjyu.

The National Health and Medical Research Council (NHMRC) today released its updated Australian Dietary Guidelines to advise Australians about the types and amounts of foods needed to maintain a healthy diet and reduce the risk of lifestyle-related disease.

With around 60% of Australian adults and 25% of children now overweight or obese, the guidelines aim to help Australians achieve a healthy weight by cutting back on foods containing saturated fat, added salt and added sugars.

The guidelines are based on 55,000 pieces of peer-reviewed scientific research and recommend drinking plenty of water and eating a wide variety of nutritious foods every day from five key groups:

  • vegetables and legumes/beans;
  • fruit;
  • reduced-fat dairy products or their alternatives;
  • grain foods (mostly wholegrain);
  • lean meats, poultry, fish, eggs, tofu, nuts, seeds and beans.

So has the NHMRC got the guidelines right? And will they translate into healthier diets and smaller waistlines? The Conversation’s nutrition experts take a closer look at the guidelines.

Associate Professor Tim Crowe, School of Exercise and Nutrition Sciences, Deakin University:

The newly revised dietary guidelines represent a potent set of recommendations targeted at promoting health, reducing obesity, and protecting against the major chronic disease killers of heart disease, cancer, and type 2 diabetes.

The revised guidelines have a greater focus on foods and food groups rather than nutrients and this is a good step forward. People eat food, not nutrients, so it makes sense to describe more of the foods that people should eat more of and those to eat less of.

While nutritionists may spend endless hours debating the wording of each recommendation, the methods and evidence that informed them, and where they believe the emphasis should lie, are these guidelines really stating anything new? Eat plenty of vegetables and fruit, choose mostly unprocessed grains and cereals, cut back on salt, fat and sugar, and get more active. Hardly controversial stuff.

The guidelines have an important role to play in informing government health policy, and for use by food manufacturers and health professionals which is why so much time was invested into revising these and taking all views on board.

But what about for the average Australian: what do these guidelines mean for them? Having the most perfect set guidelines in the world amounts to little if people don’t follow them and this is the real elephant in the room, not debating over wording.

Research from 2004 found that only a third of middle-aged Australian women met at least half of the dietary guidelines, and from a total of 10,561 women surveyed, just two (yes, two) met all 13 guidelines. For what amounts to such basic common sense advice that your grandmother would give, it shows that dietary guidelines currently are more aspirational, than attainable for most people.

Dr Gary Sacks, Research Fellow, Deakin Population Health at Deakin University:

The newly released Australian Dietary Guidelines do not adequately consider the environmental sustainability of the food supply chain. In fact, environmental sustainability is almost completely sidelined, with a discussion of the topic included only as an appendix to the main document.

The previous version of the Australian Dietary Guidelines, released in 2003, also had an appendix that discussed the environment, and so, in effect, there has been very little progress in addressing this critical issue.

It would have been far better if environmental sustainability was integrated into the guidelines all the way through. For example, there is a clear link between over-consumption, environmental sustainability and obesity. Not only do highly-processed junk foods that are high in salt, sugar, fat and energy provide very little nutritional benefit, but valuable resources are used in their production, processing and distribution.

It is clear that, in putting together the new version of the guidelines, major public health and environmental compromises were made to take into account the profit-seeking interests of the food industry. This is a similar situation to another key government strategic policy document, the National Food Plan (released in 2012), that also does not adequately address nutrition, health and environmental considerations.

It is a travesty that the private sector has such strong influence over government policy decisions, and they should have a much more limited role in the policy development process.

Professor Clare Collins, NHMRC CDF Research Fellow; Co-Director, Priority Research Centre in Physical Activity and Nutrition

Importantly, the revised Dietary Guidelines for Australians are evidence based. They have been informed by a series of systematic literature reviews of the best available research evidence from studies investigating food, diet and health relationships from 2002 (for the 2003 guidelines) until 2009.

From the review, a series evidence statements were derived to guide how strong this evidence is. We know a lot about the relationship between nutrition, diet and health risks and there is evidence to guide the advice we give on food and nutrition.

Grade A evidence statements can be trusted to guide practice. There were a number of these, demonstrating convincing associations between nutrition, diet and health risks, such as the risks associated with obesity in infancy and childhood and later weight status (page 18), and for reduced sodium intakes leading to a decrease in blood pressure in hypertensive adults (page 74).

The majority of evidence statements were Grade B, indicating that the body of evidence can be trusted to guide practice in most situations or Grade C, indicating that the body of evidence does provide some support for the recommendations but care should be taken when applying the evidence.

The Dietary Guidelines released today provide a comprehensive source of information about what to eat to improve health. Each chapter sets out the specific guidelines, the research evidence underpinning it and how to implement the guidelines in practical ways. There is also additional advice for those with specific needs due to age, stage of life including pregnant and breastfeeding women, infants, children and adolescents, or due to being part of a population group with special needs.

There are no surprises, the guidelines address the most prevalent nutrition related issues of excess body weight, and poor food choices that increase the risk for chronic diseases such as type 2 diabetes and heart disease. There is more emphasis on reducing total saturated fat by reducing processed food intakes and returning to eating more of the basic food groups. The guidelines mention some of the new foods that have appeared on the market since 2003, such as trying quinoa and reducing energy drinks, which is helpful when choosing what to put in your shopping trolley.

Overall, the guidelines offer a way forward and there is no time to waste in helping people to adopt eating patterns that adhere to them more closely as way to help people eat better, feel better and improve their health and well-being.

Professor Peter Clifton, Laboratory head, Nutritional Interventions, Baker IDI Heart and Diabetes Institute

As far as I can see, very little has really changed since the 2003 guidelines.

There are still problems in the guidelines and some evidence seems to have been misinterpreted.

1) The benefits of dairy are overstated. They state that the evidence base has strengthened for the association between the consumption of milk and decreased risk of heart disease. This seems completely wrong, with the most recent review of the evidence showing milk to be neutral, overall.

2) The section on fat (page 71) states:

Increasing the proportion of unsaturated fats in the diet can be achieved by choosing vegetables, fruit, lean meats and low fat milk, yoghurt and cheese products, nuts and seeds and using small amounts of unsaturated spreads and oils.

Dairy products contain 50% of their fat as saturated fat, so recommending an increase in dairy to increase unsaturated fat is not particularly useful, as saturated fat will increase at the same time, with no change in the usual dietary ratio of saturated fats: monounsaturated fats. In addition, there is virtually no polyunsaturated fat.

3) We’re advised to “drink plenty of water” but the evidence this has a health effect is almost non existent. Tea and coffee are associated with benefits but tap water is not.

4) Guideline 2 recommends eating a wide variety of nutritious foods from the five food groups every day, including “Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties…”

However the evidence of benefit is purely related to whole grain and fibre and not cereals in general. There is no benefit – but possibly harm – from eating a large amount of refined grain foods and the recommendation does not truly reflect the evidence. The recommendation, therefore, should say “wholegrain and high-fibre cereal foods”.

Also, the recommendation of six serves of grain foods as a minimum for men is too high. With two-thirds of the population overweight or obese, such a recommendation will ensure continuing obesity. Fibre and micronutrient intakes can be achieved with a much lower amount of wholegrain foods than this recommendation.

Chris Forbes-Ewan, Senior Nutritionist at Defence Science and Technology Organisation:

The revised guideline on sugar appears to be sensible and appropriate, based on the strength of the evidence currently available.

The summary document correctly points out that sugar is “a major risk factor in dental caries” (tooth decay). This is something that has been known for decades. However, it also refers to a strengthening of the evidence that consumption of sugar-sweetened drinks is associated with weight gain (knowledge that is relatively new).

The association between sugar-sweetened drinks and weight gain is (appropriately) assigned Grade B level of strength. That is, it can probably be trusted, but is not completely convincing.

It is also concluded that there is no evidence to link sugar intake directly with heart disease or cancer, but consumption of sugar-sweetened drinks may be associated with type 2 diabetes and “metabolic syndrome” (a set of conditions that predispose to heart disease and diabetes).

As pointed out in the supporting documentation, the evidence is mixed and not very convincing for likely effects of sugar on bone health, and there is no evidence for an association with attention-deficit hyperactive disorder (ADHD).

Because sugar intake is relatively high in Australia, it is concluded that most people would be well advised to reduce their sugar consumption. I can’t imagine many (perhaps any) nutritionists arguing against this conclusion! However, although it is not directly mentioned (other than for older people), there is no need to cut sugar from the diet altogether. Moderation, not abstinence, is the key when it comes to sugar intake and health.

Another point that could have been added is that being physically active will help to protect against the harmful effects of high sugar intakes.

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